N3319124R0014_ATTACHMENT I - Base Access Form Blank.pdf

PRINT CLEARLY IN BLOCK LETTERS ILLEGIBLE OR INCOMPLETE

EXAMPLE: SMITH, JOHN J., BM1 REQUESTS WILL NOT BE PROCESSED

Ser 60/

Date of Request: __________________________________

DD-MMM-YYYY (Example 01 JUN 2019)

From: __________________________________________________________________________________ (Sponsor, Dept Head, Officer in Charge - Name, Rank, Department, Contact Number)

To: Security Officer, NSA Souda Bay

Subj: BASE ACCESS REQUEST

1. Respectfully request access to Naval Support Activity, Souda Bay, Crete, Greece through the Mouzouras Gate, for the personnel listed below. By my signature below I certify that the information is complete and correct.

If requesting more than 10 personnel, place “See Attached List of # of personnel” on the 1st line

ALL names must be on an attached list in alphabetical order. If # is not DOD, a color copy of the

ID must be presented with the attached list as well.

NAME LAST, FIRST, MI DOD ID, Gr. ID, or PP # NATIONALITY, RANK, SERVICE

2. Base access is for the period ____________to______________

(DDMMMYYYY) (DDMMMYYYY)

3. Purpose for access: ☐PCS In/Out ☐Temp Duty ☐Dependent/Family ☐ Transient Military

4. Reason for Visit: _________________________________________________________________

5. Point of Contact:_______________________________________________________________ (If different than “From” Line) (Name, Rank, Contact Number, Command and Department)

SIGNATURE OF REQUESTOR

(SPONSOR, UNIT COMMANDER, OR OFFICER IN CHARGE)

APPROVED:__________________________________________

NSA SB SECURITY OFFICER OR DESIGNEE

(CDO-AFTER HOURS ONLY)

NAME AND SIGNATURE OF ID VERIFING OFFICAL

VCC STAFF OR

( NSA SB PATROL OFFICER OR CDO AFTER HOURS ONLY)

APPROVED:___________________________________________

GREEK REPRESENTATIVE

FOR OFFICIAL USE ONLY - PRIVACY SENSITIVE This document may contain sensitive Privacy Act data. Any misuse or unauthorized disclosure/access may result in civil or criminal penalties.

NAVSUPPACTSOUDABAYINST 5530.14 Appendix E

U.S. NAVAL SUPPORT ACTIVITY SOUDA BAY, CRETE, GREECE